Posted
by
kdawson
on Sunday March 07, 2010 @05:14AM
from the hundred-twenty-four-bucks-a-page dept.

theodp writes "Two years after her husband's death, Amanda Bennett examines the costs and complex questions of keeping one man alive. The bills for his seven-year battle with cancer totaled $618,616, almost two-thirds of which was for his final 24 months. No one can say for sure if the treatments helped extend his life, and she's left with a question she still can't answer: When is it time to quit?"

Being happy is a small and IMHO sometimes a petty or selfish reason. I AM dying from liver failure. I do not want to have a transplant or go through the expenses. I don't want my wife to struggle through the remainder of her life because I love her too much to see her suffer by being poor again.

I'm very happy even with everything that is happening to me. I'd rather live a good life of quality than a long one without.

If you are gonna die anyway, what's the point in keeping you alive if you don't want to? It's stupid to artificially extent the life of a terminal patient just for him to be miserable a little bit more time. Just stupid.

It's easy to attack an economic analysis of health care as cold and calculating, but at some point we need to admit that it's not worth spending half a million dollars to keep an 80 year-old-man alive for an additional month.

Admittedly, it's harder in some situations (like in the article where the person is 67) than in others.

No one said the decision is easy. That's why it's so important to have living wills, so that your loved ones know what you expect and can be freed from making gut wrenching decisions when the time comes.

This is so weird to me. At a gut level, I want people to end their suffering. What bizarre torturous form of "love" demands that you keep dying (sometimes zombified) people in struggling in pain until their last breath?

What bizarre torturous form of "love" demands that you keep dying (sometimes zombified) people in struggling in pain until their last breath?

It is hope. People hope to see their relative healthy again. They remember seeing a person healthy. They miss it, and they want to see it again.

Unfortunately, some of the treatments are ineffective. They might extend life, but they will never restore health. Medical procedures are graded by mortality rate over periods of time. Ex: 50% survival at 5 years. The goal needs to be different. Effectiveness should be judged by time outside the hospital without extensive medical intervention. 50% of the time, this procedure gets you 3 more years with your family. A subtle and significant improvement.

A co-worker was an ER nurse.. She would tell me stories of people that insisted that they revive grandma, even though she had signed DNR letters. If there is any question or argument, their legal team says to always revive.. So they would get someone that wanted grandma revived, which the process of CPR would usually break ribs, and lots of other bad stuff to a frail 80 year old.. She got really frustrated trying to explain that yes, they could revive her, but she was going to die in the next week or possibly 2, and that she was going to need so much pain medicine that she wouldn't be able to talk to them anyways...

The one thing I can remember of my father dying was the useless suffering of brain cancer in the last two months. Even when he cried out that he wanted to die doctors said he was not "able to decide". This even though he did in fact already put this on paper, and had the support of everybody around him.

My mother died two years after that, struggling with the same disease fortunately in a different spot. After a while she stopped the normal medical treatment and decided against a second surgery. She died peacefully after having taken time to say goodbye to everybody she loved. It did take a long time for her to accept her fate though, and choosing to end your life that way is certainly not for the weak of heart.

If anything is wrong with the current medical system is that it tries way too hard to safe lives. It should focus on the quality of life instead. It should certainly be able to make hard choices in this matter. And most certainly it should allow patients to make their own decisions (and stop religious groups interfering with such matters.) With the savings we can make the life of a whole lot of persons a lot better.

People need to talk about this, and we need to reach a consensus to where the line is.

Actually, first we need to agree that there is, and has to be, a line!

No health care setup can be fully funded, whether private or public, as there will always come a time when someone needs something new and leading edge and they tend to be expensive. Not that money can always be thrown at the problem - I remember feeling particularly sorry for Paul McCartney when Linda died because I think I would have been looking for any and all treatments regardless of cost... and yet she died!
So assuming we can agree that any health system has a budget we need people to administer that budget and that involves wieghing up the relative merits of treatment A for one (very sick) person vs treatment B for several (not so sick) people: eg Heart Swap vs Hip Replacement.

The people making those decisions HAVE to be cold and calculating about it. This means none of the (now normal!) "how does it feel" style reporting we're now too often saddled with by lazy reporters. The argument of "what if it was your father" is a ridiculous argument - of course you want the best for you and yours but that isn't necessarily the best for 'society' - in much the same way with kidnapping/hostages. As an individual I would say pay them what they ask for to buy my freedom, but as part of 'society' I would say you should NOT pay for my release because I recognise that paying them off encourages more kidnappings!

Hmm, so I'm a troll for pointing out what people with an actual intellect all realize. Making cannon fodder of the young to prolong the lives of the elderly by what might be as much as a few months is stupid. Perhaps we can turn the youth of the world into a soylent green paste so that the elderly don't have to chew while we're at it.

Maybe she can decide at this point "hey, we should have stopped fighting here and just put him in hospice care", because she knows when he finally succumbed. But sometimes people beat cancer (rarely or often, depending on the cancer). Let's say early on they decided to go the hospice route, and he died. What is she going to think when she opens up the paper and find a story about a guy with the same cancer who lasted another 20 years?

It's really easy to draw a line on a chart and say "anybody on the right side of this line has such a bad prognosis it's just not worth the money to treat them. It's a lot harder when it's your mom.

In fairness, the fact that someone can crack a "your mum" joke in this discussion scares me a lot less than some of the other posts here that suggest "your life = your salary."

The truth is your life is worth more than your salary. For starters, even if you only wanted to focus on money, it's not just your salary that matters but your potential future salary. However this thinking is still severely flawed, humans do a lot of activities that aren't costed. They care for people, fall in love, contribute to the cultural and political life of society, write open source software, complete volunteer work and provide social engagement for others.

We should never underestimate the value of surviving, surviving is what humans do, everything else (including sex) is just a footnote.

Of course. A very widely observed human response to tragedy is to make jokes. It's a coping mechanism for many people, whether they're personally involved or not. It's cathartic and relieves the tension of an otherwise uncomfortable topic.

Do what now? Are you saying there's some law forbidding jokes about cancer? Are there any other diseases on that list or are safe to joke about menstrual cramps, MS (the disease not the software company... actually on this w/s that doesn't necessarily disambiguate!), D&V?
I used to wonder whether doctors should have a "Fuck me! Cancer" form they could just sign and hand to patients instead of all that hand wringing sad face crap!
We'd learn to dread the doctor pressing the intercom button and saying "

I'm guessing from that comment you're fairly young because the truth is there's a lot people do after 45. Many people (including CEOs, judges and surgeons) reach the peak of their career after 45. If you had kids at 28, they still wouldn't be adults by the time you turn 45.

The studies I have seen put American and European survival rates at about the same level, with normally a slight advantage to the Americans, although critics point out that reporting differences (for example, in Great Britain anyone diagnosed with cancer is included in the survival figures, while in America deaths that may not be related are not counted, plus many American hospitals publish only estimated survival percentages rather than actual counts), differing access to treatment (if you don't go to the hospital you won't get counted, which could stack the deck against socialised healthcare) and uncontrolled variables (incidence of cancers is lower across much of Europe, possibly because of differences in the health care systems) make comparisons contrived at best.

There is a HUGE amount of overhead in US health care starting with a massive markup on medicine which isn't seen elsewhere and ending with the support of a lot of middlemen.It doesn't matter if it's private or public - what matters is removing the leeches and profiteers from the system and turning it back into medicine instead of a protection racket pretending to be insurance and hospitals where care is an afterthought. The doctors are not the ones getting rich and if you want to see a nurse laugh ask them if they are rich.I doubt that the same amount of care elsewhere with the same treatments under a public system would have cost the taxpayer anywhere near one fifth of that. Remember folks, it's still a drain on the economy even if rich sick people are the ones getting ripped off instead of the taxpayer - it still hurts everyone to an extent.

In Australia, the last time I looked, around 90% of the lifetime medical expenses is spent on the last year of life. This has been true for decades.

You think you are doing good stuff, but all too many suffer and die. As a GP, my role is to keep folk alive. If I was a complete rationalist, I would work out some way of stopping useless treatments, but unfortunately that is usually only obvious in retrospect.

I counsel folk on the pros & cons of cancer treatments.

Sometimes it is obvious you are flogging a dead horse, and really they should pull out and enjoy their last days in comparative health, without the misery of chemotherapy et al, with the horrible side effects, and before you recover, the cancer catches up to you & you die in continued misery. I kept one of my mates out of lung cancer chemotherapy (in this case there really was no chance), and he enjoyed his last few good months without being stuffed by chemo. His family still thank me years later.

Then there are the less obvious cases, where the therapy may help, but usually just adds to life's burden of misery, worst just before they die.

Then there are the successes. They are wonderful, but not that common.

Sure, some guys making chemo drugs make a lot of dollars, but what drives most medicos is that we care, and we are not very good at pulling back when things are hopeless, because sometimes we succeed.

To add to this, the goal of cancer treatment isn't only remission. We treat patients to make them more comfortable as well. Excision of the primary tumor and using chemo and radiation to shrink inoperable sites prolong life to an extent, and we have good data on this, and reduce their symptoms but also have the tertiary benefit of improving the quality of life remaining. I don't think many critics understand how excruciatingly and inescapably painful cancer can be.
A comment on cost: the older and more

It's not just insurance, which is why I don't understand the current debate as making insurance the only bad guys.

I know someone who broke their leg. While in the waiting room, they asked the staff for a blanket because they were cold. They got an equivalent of an airline blanket in size and quality. The hospital charged him $395 for it plus labor.

Someone else I know needed aspirin. The staff got him one and charged $725.

I went to the hospital for stiches. Got an X-ray to check for metal parts. Had no insurance. Got charged $3500 or so. They didn't even stich, just stapled 20 staples.

Second, I remember a time when, if someone needed stitches or a cast, they went to their doctor's office. The ER was where the ambulance took you if your brains were hanging out of your skull.

Yup, but then again I remember a time that if you got a minor infection after this happened you couldn't have sued the doctor for a few hundred thousand dollars for not performing the treatment in accordance with the general standards of care, which generally translates into the best possible manner of rendering the treatment generally available.

Or, another illustration:

Suppose an oncologist advises a patient that it might make sense to just make the most of their last few weeks on earth and not suffer with chemotherapy. The patient dies in a few weeks. The family talks to a lawyer and a bunch of experts second-guess that decision and the doctor could easily end up paying a fortune for prematurely ending a life.

Suppose instead the oncologist just tells the family what the best care available is, and discloses the side effects. The patient goes through agony and dies in a few weeks. Well, what do you expect from chemotherapy, the doctor has given the patient the best care available and that's just how things go. Family's insurance pays the $100k bill and no lawyers are involved. Doctor gets paid more for administering the treatment.

And then we wonder why healthcare is so expensive... NPR had a really great two-part program on these sorts of situations a few months ago.

The problem is that the best interests of the doctor are not aligned with the best interests of the patient. Instead, we've got a situation where the best interests of the doctor are to "play it safe, spend as much as necessary, preserve life at ALL costs (because that won't get me sued)". The tail is wagging the dog, in the form of a very small percentage of patients who will someday sue their doctors.

However, the solution is not tort reform--in the sense of limiting verdicts--because the problem is not the size of verdicts. The problem is the things that doctors do in over-the-top efforts to avoid really frivolous lawsuits. (Believe it or not, many doctors are devastated when they lose a patient, and to then be sued by the patient's family just makes it worse. So, to defend their own self-image, they of course do *everything* they can to avoid being sued. Which is very expensive.) I think something more akin to the "good samaritan" laws, where the nature of a doctor's obligations are spelled out, would be a better choice.

I just had to pay $1300 in out-of-pocket expenses for my daughter to get a single stitch (emergency room visit because it was after hours). And the doctor was on the fence as to whether nor not she needed one. Had I known it was going to cost me $1300, I would have used a band-aid.

There is a HUGE disconnect between medical services and pricing. How many of us ask doctors about how much something is going to cost? How many doctors tell us this information up-front?

That's why I think there should be a law that hospitals/doctors MUST present you with a bill BEFORE they do anything (except in the case of an emergency). i.e. they're not allowed to charge you for anything unless you've signed the bill for it first.

"I just had to pay $1300 in out-of-pocket expenses for my daughter to get a single stitch (emergency room visit because it was after hours). And the doctor was on the fence as to whether nor not she needed one. Had I known it was going to cost me $1300, I would have used a band-aid."

Maybe the reason the health care system is overburdened is because some people bring their kid to the freaking emergency room for a single stitch.

Medical costs really don't mean anything. There is no rational or justification for any of it. They are just made-up numbers

Really? Do they just make up the price they pay for materials, for electricty, for oxygen deliveries, for all of the lab tests they have to run so that sleazeballs like John Edwards can't get rich suing them into oblivion? Do they just make up the dollar amounts that they have to pay orderlies, nurses, electricians, radiological equipment maintenance people, and the costs of HIPPA c

Very simple - make medicare reimbursement legally dependent on eliminating the disgusting practice of overbilling uninsured patients. Legally mandate the same price for a procedure for everybody. The problem is right now they bill a theoretical price of $3000 for an X-ray, as somebody else just posted in this thread, but an insured patient gets $2200 of that price "waived by agreement" on their insurance statement, the hospital gets a $700 reimbursement from the insurance company, and ends up with a $100 bill to pay out of pocket.

A medicare or medicaid patient will be billed whatever the legally reimburseable and billable amount for the procedure under those programs.

The amazing part is only the uninsured patient, who is likely either young or poor or simply unlucky, is the only yutz who ever gets billed $3000. That is a made-up number. NOBODY else pays $3000. I promise you. My mother was hospitalized for a long period of time and I used to get these bills all the time for $2k-$5k procedures done while she was there. Reimbursement was generally between 20% and 40% of the theoretical billed amount. Even when a procedure was not reimbursed at all by the insurance company, they often would waive 60-70% of that theoretical cost "by agreement with insurance company" so I'd end up owing 500-600 bucks instead of thousands.

This practice should be made illegal. It's really despicable and punitive to the uninsured. If the hospital knew that medicare would immediate cease all reimbursements if they discovered this practice occurring, they'd suddenly find a way to bill a true, common price for the same procedure, not a hypothetical maximum which represents the most they think they could ever extort from any insurance provider or individual payer.

There is a HUGE amount of overhead in US health care starting with a massive markup on medicine which isn't seen elsewhere and ending with the support of a lot of middlemen.
It doesn't matter if it's private or public - what matters is removing the leeches and profiteers from the system and turning it back into medicine instead of a protection racket pretending to be insurance and hospitals where care is an afterthought. The doctors are not the ones getting rich and if you want to see a nurse laugh ask them if they are rich.
I doubt that the same amount of care elsewhere with the same treatments under a public system would have cost the taxpayer anywhere near one fifth of that. Remember folks, it's still a drain on the economy even if rich sick people are the ones getting ripped off instead of the taxpayer - it still hurts everyone to an extent.

My Dad was a doctor - a GP - in the UK and back in the 80's I remember him telling me about "medical insurance" for Drs, in case you get sued. He told me that Drs in the US paid more in insurance premiums than he earned per year! Who's benefiting from that and who's paying the cost!

Unfortunately that is bullshit fed to you by expensive PR.An example demonstrating it very clearly is the cervical cancer vaccine developed with Australian taxpayers money, certified to US standards by the Australian taxpayer (similar to Australian standards so not a lot more) and licenced to US manufacturers for a very low fee. Guess what - it costs more than twice as much as anywhere else in the USA with the "R&D" excuse without a single dollar spent on research and development by those jacking up the price..Most US commercial medical "R&D" is finding loopholes in patents or slight refinements in research paid for by taxpayers somewhere, often US taxpayers. There are exceptions but the markup seems to be an order of magnitude more. It's really just a way to lie about profit instead of being up front about it. Since there is very little competition in that market there is a lot of room to gouge money about of people instead of just making a comfortable living.

Yeah, but language in health care legislation to encourage people to create living wills (when they are neither demented nor unconscious and can still make such rational decision on their own) was eliminated because people referred to such discussions as "death panels".

So, instead, more people have made no such indications until they have severe dementia or are in a coma, and then next of kin (spouse usually) have to make the choices, because otherwise the doctors would be making them on their own.

My mum suffered a seven year death with cancer. It certainly didn't cost anywhere near that. Dad has just retired this week, I shit you not, with his new wife (of one year, mum died 2001) and is very healthy with money. Mum would have died in that first year without the excellent public health care system that Australia has (or rather, used to have).

You really need to focus on the important things and stop bitching about the little, meaningless crap.

Time to quit? I never got to have the 'now I'm older, what made you the person you are?' talk with my mum. Dad focuses on the future and won't talk about what used to be. Kids will eventually want to know.

Quit when you are sick of fighting or when your kids are ready for you to go.

It is a sad day when one decides to value the dollar worth of a human life.

It is indeed sad, but life is sad that way. If you don't think about the dollar worth, more human lives are lost. As she said in the article, the deceased himself, had he known the costs of his care could be used to vaccinate a tremendous amount of third-world children - he would have preferred the money be spent that way.

It's important to realize, as you do, that human life is not equal to any monetary amount. But it's also important to realize that we have a limited amount of resources, and we need to think about how to utilize them, to have the best possible effect on people, including saving their lives. That includes calculating how much it costs to keep a person alive.

This is not an either/or choice, and to say it's due to lack of resources is disingenuous at best. There is more than enough food in the world to feed everyone. More than enough manufacturing capacity to vaccinate everyone. And in short order there could be more than enough hospitals and doctors to treat everyone who is sick. The reasons we can't vaccinate/feed/cure the world are not because we can't due to lack of resources, but because WE CHOOSE NOT TO as a society. (either directly or indirectly by s

Unfortunately no matter what health care system is used there is a dollar value on life. Would you say that it is value for money to spend the entire revenue of Microsoft for one year to extend someone's life for six months? One month? One week? Because at some point pretty much everyone will draw the line, and then you are putting a value on human life.

I can only use words like "inevitable." I've lost loved ones in various ways... the inevitable grandparents, a parent, a son, friends... It's just another ending among many types of endings just as there are many types of beginnings. I'm neither happy nor sad about either. I just can't think in those terms any longer. Have I grown up or have I simply grown numb or indifferent. As I still enjoy life in general and can't help but smile at the antics of my youngest son, I doubt numb is what I have become. I think I have learned better than many how to let go and say goodbye. That lesson came easy when my mother died after a long agonizing time of waiting... for the inevitable. When I got word she died, the first word that came to mind was "finally" and I was happy... well, relieved is a better word. I didn't want her to die, but it was better than the suffering she endured for several years.

I think it would be good for everyone to get it through their heads that life always ends. It is merely a matter of time and circumstance.

The parties wanting more than half a million dollars from all of that will likely never see all of it. Insurance may cover some of it, but who knows what manner of weaseling they will muster up to lighten their own damages. The wife will not be able to cover the difference unless they were particularly loaded and I don't really care. I think the money could have been better spent on happier things. My favorite gifts are the ones I give to others and that are truly appreciated and enjoyed. I can't imagine someone spending that much money prolonging my own suffering.

In f.e. Sweden, the cost for this case, over 7 years, would've been a staggering whole lot less in the shape of the extra taxes we pay here for our free healthcare (yes, I do consider it free after all). Over here, everyone helps to pay for everyone, and people get the care they need without being subjected to "pay lots, or get out". Over there, people die, or go broke in the process of staying alive.

Yeah, it sucks for him, but I bet I could find ten other people who could live six years longer on average with just $60,000 to spend on their health care. Medication they couldn't afford, living conditions that are toxic, not having enough food, being in need of rehab, hell, just finding cancer early so it can be treated.
Not to mention what impact that money would have in third-world countries.
$600,000 kept him alive for seven years...That could be two reasonably-paid people working full-time on HIM ALONE, for seven years straight. Think of what else they could do, what other benefits they could bring to the world. Or hell, that money could pick a smart but poor high-school graduate out of Wal-Mart and put him through medical school to become a doctor. Yes, there's a point where the money ought to be spent on someone else...especially when it's public money.

Since it's less than the price of Carly Flonina's stupid Devil Sheep advertisement who are we to say it's more of a waste of money?There must be quite a few health care executives with no medical training or medical experience at all that get paid far more annually than that. There's a vast industry and only a tiny proportion of it is focused on health care, most of it is about carving out monopolies to maximise profit - you can forget about the "free market" because it does not apply.

Why is it when we have health care discussions, the media tends to quote widows and widowers? They are not experts in health care and they are not unbiased. Sure, her story is interesting and compelling, but does it tell us anything useful about medicine in the US?

The cancer must have been one of the aggressive ones. I see the 600K billed is on the low side. The actual payments to the providers would have been less 125K. Typically the terminal patients generate 1M$ in bills in their last 24 months. And generate about 300K in actual payments if they die in a hospital.

True, it's horrendously expensive. But that money pays for research, and that research will allow people to stay alive or even get cured a lot cheaper later.

People aren't going to pay half a million for battling cancer forever. At some point it'll be understood and become curable with a few of the right pills and injections. But for that to happen, somebody needs to try the less understood or experimental treatments and see if it works out.

Incidentally, I believe that paying for the "vaccine for nearly a quarter million children in developing countries" is on the long term a rather pointless thing. Doing it that way we'll just be shipping vaccines over there forever. Instead, money should be invested on infrastructure in those countries that need it, so that they can manufacture their own vaccines. Also, actually allowing those countries to manufacture them by eliminating the need to obey the patents would do a whole lot more of good.

But, if when people got cancer they decided to just take pain relief medication and die quietly, nobody would do any research. Somebody has to fight until the bitter end. And those people are precisely those who try the experimental medicine, in case it helps. Even if research was entirely funded by donations, somebody still has to volunteer to try it.

The first heart transplants were a desperate gamble, but now thanks to all the attempts many peo

I was struck by the information provided in TFA about the billed prices and the negotiated payments.

(If you didn't bother reading it) several times she mentions that her insurer paid a negotiated rate for a procedure or drug, and that negotiated rate varied when she switched jobs and changed insurers. Discounts she mentions varied roughly from perhaps 20% to sometimes far more than 50%; individual insurers would negotiate what they were willing to pay for something and the hospital would agree to consider that amount to be paid in full, regardless of the hospital's standard billed amount for that "something".

It led me to wonder whom, actually, pays the full amount? Then it struck me. The uninsured do.

Actually, from what I've been able to glean, the uninsured pay much more.

Here is the problem - you don't get the bill until AFTER services are rendered. For kicks, go ahead and ask your doctor what a procedure he is recommending will cost. He'll look at you like you're an alien.

So, you get a bill. The problem is that now you've already incurred the service, so you can't decide to shop around. You can try to barter, but bartering after the sale is not very effective. You're relying purely on the hospital's generosity. However, if the hospital really were generous, why would they be mailing you a bill for $100k knowing that most insurance companies would only give them $20k?

Most likely you'll talk that $100k bill down to $30k and then talk to your friends about how nice the hospital was to you. What you don't realize is that they give a better deal to every insurance company on the planet. Nobody pays sticker price.

If I were running US healthcare one of the first laws I'd pass was that hospitals would need to publicize a full price list, and that EVERYBODY pays the same price. Since the hospital doesn't want to be dropped from every insurance plan in the country they'll publish a fair price, and then there is no penalty for not having insurance, or for having an insurance company without a lot of patients in the local area. Note, I am under no illusions that this would fix US healthcare entirely - it is a huge mess that needs MANY changes. This would just be one of the first I'd pass, since it saves money regardless of whether taxpayers or private insurers are paying for care.

Some of the comments refer to a life as "invaluable". Money has no meaning, etc.

People in Africa get AIDS, and we all sit at home watch them die. We do nothing. The people who post these types of comments could send all their money to save as many people as possible, but they don't. The US government has the resources to save these people, but the US government withholds the money and watches them die.

The reality is that resources are finite. A society could devote all its resources to health care and do everything possible for everyone, but where does this leave the rest of us?

I could not buy anything for the next 20 years and save up an extra 500K USD ( this is above and beyond normal retirement saving ). This way, when I eventually get to my last year or two, I will have the money on hand to handle my own "spare no expense" end of life care. What impact does this have on the economy and my quality of life when I'm healthy? One needs to multiply this number by 300M people to get the scope of the entire US health care problem. These are real problems with a huge impact on both the living and the dying.

Finally, Europe is no panacea. For instance, England deems many new cancer drugs as too expensive. Cancer survival rates suffer due to England's cost cutting.

The kind of cancer drugs that NICE (the body which decides which treatments are covered by the NHS in England and Wales) rejects are not exactly 'life saving'. The most recent examples tend to extend life by a few months, but are extremely expensive. NICE uses a formula to calculate whether a treatment is value for money, and they actually made an exemption for life prolonging cancer drugs to allow some of the more expensive ones to be used. Make no mistake, NICE does not reject cancer curing treatments.

I'm going to repeat a point one other person made, just to make it again: In addition to the direct societal costs (which, I realize, can't even be easily quantified based on TFA: 600K? 400K? The amount charged, the amount paid, the amount paid less the patient's insurance premiums, divided by the number of people paying into policies for the two insurance companies?) and benefits (a few more years for 2 kids to have their dad around, an article investigating health care costs, a discussion on Slashdot on healthcare economics) there is also the advantage of having one more data point.

Because this guy was willing to keep trying, going through significant suffering for the benefit of his wife, his children, and a few more months of life, the medical community knows that a given group of drugs can extend the life of a kidney cancer patient by up to 17 months. The next kidney cancer patient, and the next cancer patient, and the next doctor looking for a way to treat this person who just walked in,and the next researcher investigating how these drugs work, all have a bit more information than they did before. They may decide that it's a goal to shoot for, or they may decide that the regimen is not quite useful. Either way, it's more than they knew before.

Of course, we can't determine the value of that, any better than we can determine whether the rest of the money spent was worth it. It's still a benefit we all get and should consider.

After 250+ comments I am surprised that there is no discussion of a 3rd path, e.g. cryonic suspension. Ralph Merkle often presents a 2x2 decision matrix with "cryonics works / doesn't work" on one axis and "choose / don't choose cryonics" on the other axis. In only one of those boxes does one come out surviving. Yes, in one box, one comes out as "stupid" (cryonics doesn't work + choose cryonics) -- but asserting the negative (cryonics doesn't work) is a very hard thing to prove (esp. when asserting the alternatives -- disassembly by cremation or microbes are fairly certain to "not work").

Given that current prices (which I haven't checked lately) were of the order of $30-$50K for head/brain preservation and $130-$150K for whole body preservation it looks like the costs are 4+x cheaper for allowing a hospice path "death" followed by immediate cryonic suspension vs. the current medical paradigm of pulling out all the stops (no restrictions on costs) end-of-life care for people who are certain to die (and have presumably a low quality of life during that period).

I would request that you not even think about responding to this post in a "cryonics won't work" vein unless you really know what you are speaking about (meaning you really understand nanotechnology and nanomedicine and have a good working knowledge of cell biology and current cryonic suspension (vitrification) processes -- the information is out there on the WWW if one bothers to educate oneself). By and large I consider the current medical community to be guilty of malpractice if they only present the two "standard" paths (hospice care vs. full medical intervention) and leave out cryonic suspension. It is interesting that in the current debate regarding controlling health care costs that cryonic suspension has not come up in the discussion as an alternative.

Though it may not have done much for him, the same treatments may have better results on others on average, and therefore be worth it. Or maybe not. Also, medical bills tend to be grossly inflated, so the real cost may have only been something like $150,000. It's a quadruple the price and give the insurance company 75% off scam (but still charge the cash customer the over inflated price, partly to make up for cash customers who don't pay).

You suggest that the desires of the patient are the ONLY thing that should be considered when deciding on treatment plans.

However, there are others who have a legitimate stake in the matter. In particular is whoever is paying for it.

Suppose that for a cost of one billion dollars I could extend somebody's life for one year, completely devoid of any pain or suffering. It would be a very fulfilling year, one that anybody would want to live.

Who wouldn't want that? One more year with their family, one more year to accomplish whatever it is that makes somebody feel happy about living. If left up only to the recipient of such care, everybody would elect to have this treatment.

However, at a cost of one billion dollars each the entire human race would essentially be enslaved to providing for the care of maybe a few thousand or tens of thousands of people who manage to receive the treatment before the entire planet runs out of resources.

Obviously a billion dollars is a contrived example. The opposite contrived example would be ten dollars - I think virtually everybody could agree that for taxpayers to balk at spending ten dollars to extend somebody's life for a year sounds very stingy (although one could debate that we do this all the time when we ignore starving people in poor nations).

So, at this point we're just haggling over price. At what point do those actually paying for care get to say "enough is enough?" That is exactly what this article is about. Talking about putting a price on life sounds barbaric, but the fact is that everybody does this every day - they just don't talk about it.

Here is something else to think about - if you really do consider my life to be worth a million dollars per year, or whatever, can I elect just to receive the cash for two years of life right now and then thirty years from now you can just let me die in peace?

Ever notice that all the "fixes" proposed in Washington revolve around getting more people into this failed economic model and accommodating the costs? No one asks why a scan costs some $3000 or why a drugs costs $750 per dose.

It's time to just re-tool the whole thing from the ground up, focusing on having prices that reflect the actual costs or services. A probably not so far fetched example, a one million dollar MRI machine. Amortized over 5 years, 8 scans a day, that comes out to about $68. Add on the technician's fees and misc. for power and space in the hospital and your scans should not cost more than a couple hundred dollars sans the radiologist's fees to read them.

Health care reform should be 100% about bringing transparency and predictability to the costs. Only then can you look at how to cover more people.

I work in a publicly funded tertiary hospital in Australia. I'm not medical (I used to be a medical scientist) so I don't have the hands-on, day-to-day experiences of the clinical side of the hospital, but I do get to have glimpses of a 'big picture' view of it.

The head of radiology recently told me that the Uni was willing to "donate" a big expensive machine. Poisoned chalice, he said. They get all the kudos (and access to it for research), the hospital gets the bills. And no funding. Things like:- floor space (and these are big mofos, some machines require vibration-proof rooms, or shielded rooms etc)- installation (cranes and shit)- power, both getting massive amounts of power to it and paying for massive amounts of power.- operators- maintenance (that's a biggy it seems)

None of these costs fit under "misc. expenses" I'm afraid.

Plus there's things like the PACS system to store all this data. Radiology has an IT storage system a little bigger than the rest of the hospital.

What you're talking about it exactly what is done in healthcare rationing. It's also been used as a football in the US healthcare debate (I think some idiot called the UK system that decides this 'death panels'). They way it's done is to ask a representative sample of the population to rate the value of a year in a certain condition. It's based on QALYs - Quality Adjusted Life Years. So, for instance, someone might say that 1 year in a wheelchair has the same ' value' as 2 years able to walk unaided, so

Sometimes the patient might want to stop, because they feel they are causing you trouble and wasting your money (i.e. the patient is your mother or father or husband).

Yes, this is a problem with any sort of expensive care, especially the long-term kind.

You however must show them you love them...

Yes, that's always important.

...and keep on trying. This will make it worth in the end.

I'm going to have to go with no. In the end, it is not your position, my position, or the loved one's position to choose how or if a patient should continue treatment. It is the patient who will have to live with the consequences of their choices and to take away those choices with a mantra that one must "keep on trying" regardless of the futility of the action condemns people to situations where they are forced to endure needless suffering to placate the wishes of others. If it is wrong to coerce or steer people to give up, it is certainly as wrong to coerce or steer people to keep on trying.

I'd say when the person is suffering 24/7, and the odds of them ever getting any better are pretty much zero, it is time to seriously consider letting them make their peace and just letting them go. Look at it this way, if it was a dog suffering that bad, would you put them out of their suffering? Then why the hell subject someone you love to that much pain?

When my sister passed away last year they probably could have kept her around for another 4, maybe 5 years, first by hooking her to a vent followed by an iron lung. But her nervous system was already shot, her bones were as brittle as twigs, she hurt pretty much 24/7, and if they would have continued she would have ended up unable to speak, move or even communicate. What kind of "life" is that? In the end we were lucky that sis had a compassionate doctor, who gave her enough morphine she just drifted away in her sleep. A hell of a lot nicer death than the slow suffocation or being nothing but a slab of meat wired to machines, unable to even speak.

So I would say when there is no hope and they are suffering it is time to seriously think about just letting them go. Forcing them to soldier on with nothing to look forward to but more pain is simply cruel. And I know they are talking about an economic standpoint here, but I wonder how many of those were the choice of the patients, or the NOMW (not on my watch) docs? Before my mom retired as a nurse she worked a NOMW case, where a doc kept a 22 year old girl "alive" for 9 days because he refused to give up and told the family there might still be hope. This poor girl hit a guard rail with her head at nearly 70 and my mom had to put towels around her head when the family visited so they would see her brains slowly leaking out from the swelling.

So I would say someone needs to step in when it is obvious we are at 0% hope and have everyone seriously look at what the future holds. with technology we can keep a human body often going long past the point of failure, but not only is it expensive as hell, it is seldom a pleasant or an easy way to go.

I'm assuming by "brain leaking out", you mean that they performed a decompressive craniectomy. With such treatment, even someone with a severe head injury has some chance of survival without serious damage. What the doctor did in this case might not be at all unreasonable, depending in large part on a lot of subtle considerations like whether the patient had good pupil response on admission, the age of the patient (which in this case leads to a much better prognosis than with an older person), etc.

In one (admittedly small) study of severe head injury cases (all of which, AFAIK, would likely have been described in much the way you described this case), fully half of the people who underwent such surgery survived, and a third survived with no or minor disability.

In other words, the outcome is not always clear from outward appearance or even from the severity of impact. The doctor might well have legitimately thought the girl had a reasonable chance of recovery. Nine days is not really unreasonable. Brain swelling can easily continue for a couple of weeks, and I actually had a teacher once who was in a coma for many months (or was it years, I forget). I'd have to know a lot more than you've given me before I would agree that the case was hopeless.

The real problem with the American healthcare system is that the cost of treatment often has to be met by the family of the sick patient.

Should people be made to face the choice of continuing treatment or costing their families future. Should your wife be forced into living in a trailer park as your widow your children forced to withdraw from college in order to maintain your life for a few more years?

Essentially it becomes a choice of suicide or putting the people you love most through intense hardship, probably worse than that since suicide would invalidate any life insurance so you need to bare the pain of cancer for as long as your body holds out.

I'm lucky I live in a country where most of my medical needs are taken care of some options will be limited due to cost and the benefit they provide. However I will get treatment and my family will be ok.

Health care is the number one reason for not wanting to live in the usa.

I want the entire worlds population to exist for the express purposes of keeping me alive and well for as long as imaginably possible.

Period.

The sad reality of the American situation is that if YOU break your leg and then have it mended, thats going to cost thousands upon thousands of dollars, but if YOUR DOG breaks its leg and then you pay to have it mended, the cost will be under a grand. The reason for this is that SO MANY PEOPLE HAVE HEALTH INSURANCE FOR THEMSELVES, BUT NONE FOR THEIR DOG.

Your time alive is worth more than your family's home, education and future? You would give the children to the state because all of your income above the barest essentials goes to pay current and back medical bills that cannot go away because bankruptcy only works once? You would transform 20 years of your spouse's retirement into 20 years of working at Walmart so they can eat for another week of life?

If you don't have a family then I agree, your life is worth everything you have and everything more you can borrow or talk out of someone. Unfortunately although it's true you can't take it with you its also true you can take other people down before you go. "My life is priceless" makes sense when the decision is between not buying a nice car or a new video game vs. dying but that's not the amount at stake when you pay for medical care. To choose imposing financial ruin and associated suffering on people you presumably love to put off for a few months something that we all must eventually do is simply selfish.

It's not until you consider these implications that you can really say "I would pay any price for one more day of my life."

Only make $15/hour? I'll assume that you make considerably more than that. If that's the case, you become a bigger loser for trolling around on/. for what "you're worth" versus what "he's worth". He's wasting $15/hour and you are wasting considerably more.
When did hourly income become the value of an individual?

Life can be worth infinity and you'd still need to take into account the cost.

In particular, opportunity cost of NOT spending that money on someone else, perhaps in a more efficient manner.

Bear in mind that resources devoted to keeping one person alive are resources that cannot be devoted to keeping other people alive.

Withholding services can kill a terminal patient just as easily as withholding comparatively much cheaper food and water from healthy people can get them starved to death, or worse into a bed right next to that terminal patient.

Respect for human life aside, I think money is better spent on prevention, and on keeping that "patient" from winding up in an expensive hospital bed in the first place. That saves their life, and to boot lets them live happily, and with enough money left over to similiarly save a dozen other people as well.

Lives versus dollars will never make a good comparison. However, lives versus lives might.

In your case it's 300 €, but keep in mind that the amount you pay for insurance is directly linked to your income, not to how much you've been sick last year. You could argue it's unfair that you have to subsidize a bunch of students and old people for a while, but it sure beats any other system I've seen. I agree it's not fun to pay the insane amount of insurance and taxes here in Europe, and yes, a huge part of it is going to be wasted on government pork and mismanagement. We need to address that. I'd speculate we could cut those insurance premiums in half if we abolished all the profiteering, corruption and misappropriation. But all in all, it's the price we pay for a pretty decent attempt at social equality.

On my own, my health insurance choice is a limited $1,500 a month plan and an average $2,500. Those are different companies, and the only ones selling insurance in my state (in the U.S.). I'd say Germany's plan looks OK to me.

Luckily there is a group for freelancers in my state, but keep in mind:

You have to be relatively successfully every year in order to qualify.

You have to do one of several types of job.

If you have no income (say 10% in the U.S.) or low income, you are screwed.

If you're really pissed about this, then you haven't really thought it through.

Natural resources are finite. The supply of human labor is finite. It is impossible to expend infinite amounts of resources extending human life. You've been lied to if you believe you don't have to care about these truths. And if your government is the one who has told you this lie, that just means that they will take on the responsibility of reconciling any disconnect between your perception and reality, by force, whenever necessary.

The sad part is that his life was likely extended a bit, only by the fact that the family could AFFORD it. An unemployed or uninsured person would very likely have died much sooner from lack of treatment or medication due to the fact that they could not pay for their care. This is just wrong and healthcare in the US really needs a reboot. When insurance companies have near-total control over your treatment, what drugs they will pay for and for how long, etc., the system is TOTALLY BROKEN. Doctors and care p

Should doctors work for free? Should drug companies not be compensated for the work they put into making their products? Should a construction company build a new hospital, from scratch, with no reimbursement?

Health care has a dollar value because the things which comprise are not free. How twisted are you Europeans because you think, just because you don't pay for these things directly, that no one has to pay for them at all?

You do realize that in your country, somebody asks this question too. Assuming you live in a country with a single payer system, the people who run your single payer system have already decided what they are willing to pay and for which procedures. The way they do that is generally looking at dollars spent vs. quality-adjusted-life-years purchased for their taxpayer citizens, and similar health economics measures. I agree that the system in the US is fucked up in many many ways, but having to consider costs in medical treatment is a reality of finite resources and it happens everywhere.

It's pretty easy to say that when you're not facing a terminal illness. No one can truthfully say how they will react to a very difficult decision like that until it actually happens. We can say how we would hope to react, but to suppose we would make a better choice than someone else is dishonest and arrogant.

What Americans and right wingers don't get, is that some people prefer a humane society over low taxes in a hellish environment were there is a dollar amount for every human life.

Some of us value humans more then money. You clearly do not. To bad. Maybe one day you will decide to join the human race. Usually about the time when it is your life that is being represented by a dollar amount.

The inability of some people to put kneejerk emotional reactions aside and rationally consider whether it's reasonable to spend a considerable fraction of many people's total lifetime earnings for the sake of extending the life of a very sick person for a few months or years is disconcerting. It's fine and good to pretend money is no object when you aren't the one paying for it, nor the one suffering bedridden and perhaps barely conscious. When you consider your typical middle class American spends most of